6th & 7th Grade Fall 2020 Afterschool Cohort Application

VAI Afterschool Cohort | 2020 Fall 6th & 7th Grade Application

The Van Andel Institute for Education (VAI) Afterschool Cohort is committed to advancing and promoting science education and increasing the number of students who choose to pursue careers in science or science-related fields. We are looking for students who are curious, passionate about science, and enjoy working with others. Students in 5th and 6th grade in Fall 2020 are eligible to apply. Students and Parents must commit to participating for one semester. Participation is secured on a first-come, first-served basis.
  • Participant Information:

  • Participants Name * Required
  • Which of the following best describes your child's race or ethnicity? Check all that apply.
  • Type of School * Required
  • Please identify any significant medical condition (i.e. asthma, diabetes, allergies, etc.), or injuries that may affect your child’s participation.
  • Parent/Guardian Information:

  • Parent/Guardian 1 Name * Required
  • Address * Required
  • Relationship to Participant * Required
  • Parent/Guardian 2 Name
  • Address
  • Relationship to Participant
  • Applicant's Story & Parent Recommendation

  • Tell us about yourself. What are you curious about? What interests you? What is your favorite subject in school? Why? What do you do outside of school? What do you want to know more about? Upload the applicant's story below.
  • Please explain why you would like your child to be in the VAI Cohort Program (include ways your child demonstrates creativity and curiosity, and give examples of how your child enjoys working with others). Upload the parent/guardian recommendation below.
  • Release and waiver of liability, assumption of risk and indemnity and parental consent agreement:

    This Release and Waiver of Liability, Assumption of Risk and Indemnity and Parental Consent Agreement (the “Release”) is executed as of the date set forth below on behalf of Participant by his/her parent or legal guardian (“Guardian”) in favor of VAN ANDEL INSTITUTE FOR EDUCATION and its directors, officers, employees, agents, trustees, affiliates, successors and assigns (collectively, “VAI”). Participant (named below) desires to attend VAI’s Afterschool Cohort Program (“Program”) and engage in the activities associated with the Program. In consideration for participating in the Program, Guardian hereby freely and voluntarily, without duress, executes this Release under the following terms:

    Guardian Status; Consent. By my signature below, I attest that I am the parent or legal guardian of the Participant named below, and that I have the authority to execute this Release on behalf of the Participant. I consent to Participant’s participation in the Program.

    Waiver and Release. The Guardian and Participant release and forever discharge and hold harmless VAI from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise from the Participant’s participation in the Program. The Guardian understands and acknowledges that this Release discharges VAI from any liability or claim that Guardian or Participant may have now or in the future against VAEI with respect of bodily injury, personal injury, illness, death, or property damage that may result from Participant’s participation in the Program. IT IS MY LEGALLY BINDING AGREEMENT BY THIS RELEASE TO EXEMPT VAEI FROM ALL LIABILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE AND WRONGFUL DEATH.

    Medical Treatment. The Guardian and Participant each hereby release and forever discharge VAEI from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during the Participant’s time at the Program.

    Assumption of Risk and Indemnification. The Guardian and Participant each understand that the Participant’s participation in the Program may involve activities which can pose risk of harm or injury to the Participant. As the Guardian for the said Participant, I, and the Participant, hereby expressly assume the risk of injury or harm in these activities and release VAEI from all liability for injury, illness, death or property damage resulting from the Participant’s participation in the Program. Guardian and Participant agree that if anyone makes a claim against VAEI, on behalf of Guardian or Participant, that Guardian and Participant agree to indemnify, save and hold harmless VAI from any claim, including without limitation, loss, liability, damage, or cost which may occur as a result of any such claim.

    Photographic Release. As the Parent or Guardian of said Participant, I, and the Participant each grant and convey unto VAEI all right, title, and interest in all photographic images and video or audio recordings made by VAEI during the Participant’s participation in the Program.

    Other. The Guardian and the Participant each expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Michigan, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Michigan.

  • Electronic Signature of Parent/Guardian * Required
    By signing, I am verifying that the information I have given is true to the best of my knowledge and that I have read, and I understand and agree to the terms which are listed above.
  • This field is for validation purposes and should be left unchanged.